Provider Demographics
NPI:1114040870
Name:LORD, SUSAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:LORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ROSSETTER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230
Mailing Address - Country:US
Mailing Address - Phone:413-644-9600
Mailing Address - Fax:413-644-9601
Practice Address - Street 1:33 ROSSETTER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230
Practice Address - Country:US
Practice Address - Phone:413-644-9600
Practice Address - Fax:413-644-9601
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD30012207Q00000X
MA234864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine